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Introduction: This practice-based research study capitalized on the statewide implementation of a comprehensive, locally-driven initiative to implement evidence-based policy, system and environmental changes related to obesity and tobacco use. The study examined local health department (LHD) performance and factors such as organizational quality improvement (QI) maturity, structure and governance. Methods: State health department staff reviewed grant reports and documentation pertaining to all LHD grantees, which collectively represented all 87 counties and 4 cities in Minnesota (MN), in order to designate grantees as either: “Exceeds Expectations,” “Meets Expectations” or “Approaching Expectations.” A study team of state, local and academic partners then used select measures from the QI Maturity Tool to calculate a QI Maturity Score, and subsequently place grantees into three levels of QI maturity: low, medium and high. Multivariate regression was performed to examine the potential relationship between grantee performance and QI maturity, as well as other covariates. Results: Of the final sample of 91 counties/cities, 87 had complete data for multivariate analysis. The distribution of grantee performance was: exceeds expectations (29.7%), meets expectations (55.0%) and approaching expectations (15.3%). Organizational QI maturity was strongly, positively associated with grantee performance comparing the “exceeds expectations” to those who “met or approached expectations” (OR=4.29, 95 % CI: 1.90-9.73, p=0.0005). Implications: Organizational QI maturity was strongly associated with LHD performance. More research is needed to determine whether a more mature approach to quality improvement is merely a marker for overall LHD capacity or has its own unique contribution to performance. Findings have been used to inform the next funding cycle of this initiative and provide support to implementing annual assessment of QI maturity in MN.

This study examines property tax levy (local tax levy) as a source of local health department (LHD) funding during a five year period (2006-2010) in all Minnesota counties by assessing fiscal effort, fiscal allocation and fiscal capacity. Local health departments rely on pluralistic funding from local, state, federal and private sources. However, local tax levy funding is unexplored and little is known regarding the extent of fiscal allocation (tax levy used for LHD), fiscal effort (potential amount of tax levy available for LHD), and fiscal capacity (wealth of community). More important it is not known to what extent variation between local jurisdictions fluctuated over time, how they are offset by declining funding from other sources, or whether other sources supplement total tax levy reductions. It is essential to explore these issues to provide a basic understanding of fiscal drivers for ongoing services. Our findings indicate that from 2006 to 2010 the local tax levy for public health as a percent of total local health department expenditures decreased 6.7%, while local tax levy for public health as a percent of total tax levy decreased 14.6%. However, during this time period the total per capita tax levy for all services increased 25.2%.